Heterogeneity of type 2 diabetes in rural India

SUVARNA NETAJI PATIL^*Ajay PatilKaustubh TarePallavi BhatAkash KumbharDatta MulayDnyaneshwar JadhavVaibhav MethiSachin SurnarTushar HumbareAniket KhaladkarShreyansh DeosaleCharudatta Vaman Joglekar

• BKL Walawalkar Rural Medical College, Chiplun, India

Background: Prevalence of diabetes continues to rise in India. The rise in diabetes, previously concentrated in urban areas is also occurring in rural India, even though the rural population is predominantly non obese/lean, under nourished and physically active. Type 2 diabetes and its pathophysiology (hyperinsulinemia and insulin resistance) among obese, over-nourished and physically inactive urban populations are very well characterised. However, there is a paucity of such characterisation among those non obese/lean, undernourished. We attempted to characterise type 2 diabetes in the rural KONKAN region of India using BMI, body composition, and glycaemic parameters. Methods: This cross-sectional study was conducted among 508 subjects with type 2 diabetes, visiting the rural tertiary care centre. They underwent anthropometry, body composition, and glycaemic (glucose, HbA1C, C-peptide) measurements. Various HOMA indices for insulin resistance (HOMA-IR), β-cell function (HOMA-β) and insulin sensitivity (HOMA-S) were calculated. The subjects were classified into six groups; the classification system was created by combining BMI with parameters of central obesity and adiposity for comparisons of glycaemic measurements and HOMA indices. Results: Median age, age at diagnosis and duration of type 2 diabetes were 59, 51.5 and 5.2 years, respectively. The BMI distribution shows that, 6% were underweight, approximately 46% normal weight and 48% overweight. Central obesity and adiposity were observed in 70% and 56% respectively. Of normal weight subjects, 52% had central obesity while 29% had excess adipose tissue. The lean group was characterised by low BMI (mean 16.7 kg/m2), absence of central obesity and adiposity, and lowest C-peptide (median 463.5 pmol/L) and lowest insulin resistance. Glycaemic characteristics of overweight, centrally obese, and adipose subjects were similar to those observed in classical type 2 diabetes. Conclusion: The use of BMI and simple body composition measures led us to identify a distinct lean phenotype that was characterized by low BMI, poor insulin secretion, and absence of central obesity and adiposity. Further research is warranted to understand the pathophysiology and develop a personalized medicine approach for lean subjects with type 2 diabetes. It's time to reconsider glucocentric, one-size-fits-all approach for treating type 2 diabetes.